Getting ‘Better’ with a personal health assistant

April 23, 2014 | by | 1 Comment

Is Better going to where better healthcare should be?

[grow_thumb image=”https://telecareaware.com/wp-content/uploads/2014/04/pha.jpg” thumb_width=”150″ /]Making its formal debut last week was Better, an iPhone app (Android to come) developed in conjunction with and backed by the Mayo Clinic. The aim of Better is to deliver information and care no matter where people are located. The analogy co-founder/CEO Geoff Clapp uses is ‘AAA (RAC or AA=UK) for healthcare’ but it seems to be a bit more developed than emergency tows and TripTiks. In its free version, it provides complete access to Mayo Clinic educational content tailored to the user’s interests and provides access to a personal health record (PHR) for the family. In the $49/month premium version, Mayo provides 24/7 national access to a personal health assistant available by phone and video. The PHAs can coordinate your and your family’s providers, help navigate your insurance and billing and coordinate follow up care. If needed, the PHA can connect the user with a Mayo Clinic nurse who can explain symptoms, potential causes and recommend next steps. The paid version also provides a symptom checker, built with algorithms and using the Mayo database.

According to Mr Clapp (interviewed in Mobihealthnews), Better is ‘early’ and trying to define a market. He is encouraged by remarks such as “I’m not sure I totally get it and not sure the world is ready for this” which is similar to what he heard when co-founding Health Hero (now Bosch Health Buddy) in 1998 (among the most Grizzled of Grizzled Pioneers). Also in this interview, he cites a focus on underserved disease groups such as Crohn’s Disease and cystic fibrosis where help is not generally available; eventually they will also move toward telemedicine. Since the sale. he has been mentoring companies at Rock Health. Better has raised $5 million to date between Mayo and Social+Capital Partnership and is located in Palo Alto, California. It’s an interesting spin on concierge medicine–can it be considered ‘concierge healthcare for the masses?’ Given the pedigree and the partners, we expect to hear bigger, better things from Better in the next few months. Also MedCityNews,  the PSFK Labs blog and FastCompany. Video (YouTube)  Hat tips to Bob Pyke, Editor Toni Bunting

Data breaches may cost healthcare organizations $5.6 bn annually: Ponemon (US)

April 23, 2014 | by | 1 Comment

[grow_thumb image=”https://telecareaware.com/wp-content/uploads/2013/10/keep-calm-and-enter-at-own-risk-3.png” thumb_width=”150″ /]The PHI threat is within for HIT staff and CIOs, with no end in sight: Ponemon Institute and IS Decisions

The Ponemon Institute’s fourth annual benchmark report on patient privacy and data security was released last week and with a few exceptions, the news is worse than last year. Eight highlights in the study of 91 responding organizations (Ponemon admits results are skewed to larger sized respondents) for 2013 are:

  1. The average cost of data breaches in the study group was approximately $2 million over a two-year period. Extrapolated to the over 5,700 hospitals in the US, the annual cost is $5.6 billion, down from $7 billion in 2012.
  2. The number of data breaches decreased slightly. 38 percent report more than five in the 2013 report compared to 45 percent in 2012. The number of organizations reporting at least one data breach in the past two years was 90 percent versus 94 percent in 2012.
  3. Healthcare organizations improve ability to control data breach costs. The economic impact of data breaches for the healthcare organizations represented in this study over the past two years is $2.0 million–but it is 17 percent (nearly $400,000) less than 2012.
  4. ACA increases risk to patient privacy and information security. No surprises here for readers with insecure exchange of information between healthcare providers and government (75 percent ), patient data on insecure databases (65 percent) and patient registration on insecure websites (63 percent) leading the way. (more…)

An architect’s POV on transforming rural health

April 22, 2014 | by | 1 Comment

‘Wellness districts’ and restructuring beyond walls and payments

[grow_thumb image=”https://telecareaware.com/wp-content/uploads/2014/04/Butler-County-Elting-bldg.jpg” thumb_width=”175″ /]Healthcare building architect Doug Elting cannot be accused of thinking small. The Transformation of Rural Health starts with reimagining healthcare facilities serving rural areas into facilitators of population health: “…the  local healthcare center as the source of health and vitality….focus(ing) on the provision of services that will maintain health, enhance public participation and redefine the scope of care.” (Not difficult imagining when you see an attractive wellness/rehab center like Butler County Health Care Center in Nebraska, left.) Like Clayton Christensen, Mr Elting envisions decentralized care that incorporates telehealth, care coordination, PHRs, fitness and social support. He then moves to an organizing principle called Wellness Districts:

Rural community, county and critical access hospitals will become components of Wellness Districts composed of Life Enhancement Centers coupled with physicians and physicians groups. These Life Enhancement Centers (LEC) are flexible and agile facilities containing a variety of services meeting the needs of the population. The LECs could contain: patient-centered medical home physicians’ offices, wellness and rehabilitation centers, specialty clinics, diagnostic centers, wound care centers, nutrition and cooking classes, outpatient treatment centers and urgent care facilities. LECs may include related services including dental offices, eye care specialists and retail functions including: durable medical equipment, opticians, retail pharmacies, food services etc. (more…)

A ‘before the alarm’ approach to the soundtrack of ICU data

April 22, 2014 | by

ICUs–and indeed, any acute care setting–have a soundtrack of boops and beeps that accompany regular telemetry of data from multiple devices. Alarms which indicate emergencies shatter the rhythm, eventually inducing ‘alarm fatigue’. What if ICUs could get a step or two ahead and use the torrent of data to predict a downturn in a patient’s condition and warn clinicians before that alarm goes off? That is the idea behind the system being developed at Boston Children’s Hospital with a local data analytics startup, Etiometry.  The latter’s Risk Analytics model is designed to transform data into clinically actionable information and to predict decompensation–a worsening or emergency status for the patient. For the cardiac intensive unit at BCH, the Stability Index pops up on the vital signs screen. “Doctors choose different parameters to measure, then the Etiometry system renders its risk assessment on a simple numerical scale, with 0 being most stable and 4 the least.” Not the first innovation for Boston Children’s either; with another software provider, they developed a single view of vital signs interface dubbed T3.  Boston Globe, FierceMobileHealthcare

Nike FuelBand out of gas

April 22, 2014 | by
[grow_thumb image=”https://telecareaware.com/wp-content/uploads/2014/04/FuelBand.jpeg” thumb_width=”175″ /]In what is the first of the major players in fitness bands and wearables exiting the category, CNet reported last Friday that Nike is winding up its hardware business with the layoff last Thursday of nearly 80 percent of its Digital Sport staff. Previously, Nike had canceled a new version of the FuelBand due for release later this year, but they will continue sales and support for the present iteration which only works with Apple. Their focus is now on fitness and athletic software, which can plug into smartphones and other companies’ devices at far less cost and greater profit than the hotly competitive band business. Much of the speculation surrounds their strong Apple connection; Tim Cook, Apple CEO, sits on the Nike board. This maneuver could benefit them both greatly when Apple finally gets into the smartwatch biz. Perhaps two world-class brands could better sort out what to do with the data, which is another sore point according to PC Magazine’s take on it. Further reasonable discussion on this courtesy of Gigaom. Hat tip on the last to David E. Albert, MD via Twitter @DrDave01.  (Nike photo)

Why healthcare doesn’t encrypt: correct, incorrect assumptions

April 22, 2014 | by

As our readers know, we’ve preached the Gospel of Data Security for quite awhile, to the point where even The Gimlet’s Eyes have crossed. Based on this smart analysis in Healthcare IT News (done by an outsider to healthcare), there are real reasons why HIT leaders are reluctant to implement encryption and security that would be SOP for other types of organizations. Mr. Schuman sorts the ‘drag the feet’ factors:

  1. Outdated but still widely believed: Encryption makes information less accessible across a broad network, increasing retrieve and review time. There is increased, not decreased, pressure to increase access, including by practices and patients, as part of  Meaningful Use (US).
  2. Encryption as a barrier: Providers see encryption as increasing time, decreasing  usability of systems, making workarounds more difficult.
  3. Encryption not permitted: Equipment designed with a specific hardware/software configuration block security add-ins. The logic is that any add-ins, even for security, could and do compromise performance. They thus violate manufacturers’ warranties and leave hospitals/practices open to legal action if equipment does not perform as intended.
  4. It’s complicated and pricey: Encrypting proliferating devices multiplicity of devices and systems takes manpower–it’s not only not there, but also expensive. Good intentions, but little money, is there.

The solution may lie in encrypting data between applications, not in the hardware/software itself. Hat tip to reader ‘Klondike Playboy’ John Boden.

BlackBerry’s investment: what’s in it for NantHealth

April 17, 2014 | by | 1 Comment

This week’s news of BlackBerry Ltd’s minority investment in the Dr. Patrick Soon-Shiong eight-company combine called NantHealth has generally focused on BlackBerry. Across the board, BlackBerry is depicted as the party badly needing a raison d’être. Down for the count in both retail and enterprise mobile phone markets it dominated for years, BB’s six-months-in-the-saddle CEO is now going back to those same enterprises singing the wonders of their QNX operating system and upcoming BBM Protected communication platform to highly regulated verticals which need max security: healthcare, finance, law enforcement, government. Although FierceCMO inaccurately reported that BlackBerry was acquiring NantHealth (Reuters/WSJ reports to contrary), it’s generated yawns from former tea-leaf readers such as ZDNet as yet another flail of the Berry as it sinks beneath the waves. Add to this the bewilderingly written CNBC ‘Commentary’ under BlackBerry CEO John Chen’s byline–who should fire the ghostwriter for inept generation of blue smoke and mirrors–and you wonder why the very smart Dr. Soon-Shiong even desires the association with a company most consider the equivalent of silent movies. It is certainly not for the investment money, which the doctor has more than most countries–an expenditure carefully considered at BlackBerry, undoubtedly. 

Cui bono? NantHealth first, BlackBerry second is your Editor’s contrarian bet. Consider these three factors:

  1. Way down the column in most coverage is that BlackBerry and NantHealth are developing a healthcare smartphone. It will be optimized for 3D images and CT scans but fully usable as a normal smartphone. Release date: late 2014-early 2015 (Reuters). (more…)

ELabNYC Pitch Day

April 17, 2014 | by

10 April, Microsoft HQ, NYC

The Entrepreneurship Lab NYC (ELabNYC) presented its second annual class of companies to nearly 200 life science funders, foundations, pharmaceutical companies, healthcare organizations, universities and the occasional Editor. Of the cohort of 19 companies finishing the three-month program, 56% are now funded and 25% had first customer revenue by the end of the program. Each company pitched for five minutes on its concept, its current state of advancement (including pilots/customers), its team and a funding timeline. This Editor will concentrate on the five companies with a digital health component; she was intrigued by their diversity and focus on difficult problems of compliance and diagnosis, especially dementia and concussion. (more…)

eCaring gains Series A financing (US)

April 17, 2014 | by
[grow_thumb image=”https://telecareaware.com/wp-content/uploads/2014/04/eCaring-Screenshot.jpg” thumb_width=”170″ /]Home care management/monitoring system eCaring (New York) this week secured $3.5 million in Series A funding, led by Ascent Biomedical Ventures. Private investor Stephen Jackson will be joining the eCaring board, as well as being on the board of client MJHS. Funding will go to product development, sales and marketing targeted to managed care plans, home health agencies, payers, hospitals and related entities. The CareTracker program is unique in that caregivers/aides with relatively low English language or computer literacy can, through icons, easily input both clinical and behavioral information on a home care patient which summarizes by patient and aggregates at the care manager level. There is also a CarePortrait feature that determines baseline norms for behavior such as activity and sleep. eCaring, with Pace University, was also one of 2013’s PILOT Health Tech NY/NYEDC/Health 2.0 winners for a project with the Henry Street Settlement. A big cheer for CEO/founder Robert Herzog who has been championing this aging services/aging in place technology for several years while QS apps and fitness trackers stole all the buzz at the cocktail parties and accelerators. Release, MedCityNews (photo)

Vision therapy app for amblyopia prescribed, reimbursed (DE)

April 17, 2014 | by

Amblyopia, also known as ‘lazy eye’, is a treatable vision processing disorder where vision in one eye decreases for no structural reason. It’s often seen in young children and is generally treated with a combination of patches (to block the stronger eye), eye exercises and glasses–on occasion, requiring surgery–in a process that can take up to two years. In a young child, that is a recipe for tedium. Caterna Vision Therapy, a spinoff from Technische Universität Dresden, has advanced the exercise portion to be child engaging and downloadable through the Apple App Store and Google Play to a PC or mobile device. Caterna claims the exercises also shorten length of treatment. The therapy is CE marked for Europe and in Germany is both prescribable and reimbursable through statutory provider Barmer Gek, fortunate as the cost is €980. It may presage more apps receiving similar treatment. Videos are available in English and German on their home page. Caterna hopes to expand their vision therapies into age-related macular degeneration (AMD) and eye-tracking.  eHealth Law and Policy

Two new health applications for Google Glass

April 12, 2014 | by

Beyond the surgical suite [TTA 24 Sept, 16 Nov], developers keep building platforms that enable telemedicine consults with Google Glass. An exciting one is Beam, developed by Remedy, which allows clinicians to securely share images, text, video and location through Glass. The consult can either be live streamed (synchronous) or store-and-forward (asynchronous) through Beam’s ‘expert interface’. Harvard and The University of Pennsylvania started pilots of Beam in March. The intriguing background is that one of the co-founders, Noor Siddiqui, is but 19–albeit one who has a Thiel Fellowship which gives young entrepreneurs the $100,000 opportunity to skip college and work on their project. Fast Company/Co.Exist, MedCityNews, press release via Telepresence Options. A bit more ‘out there’ is Personal Neuro Devices’ Introspect PND Wearable, a ‘passive brain monitor’ that based on the pictures, is an add-on to Glass that surrounds the head from back to front, with two sensors that extend between the ears and eyes. Ottawa, Canada-based PND claims it reads brain waves and the app then applies the changes to provide feedback, such as special content to modulate moods (their other business.) Release, PND page with video/pictures, ApplySci

US Army mCare app’s most-liked feature: appointment reminders

April 11, 2014 | by

A two-year study on the mCare mobile messaging app used to support ‘Wounded Warriors’, published in the June issue of Telemedicine and e-Health, found that the most popular use of this US Army-implemented program was the appointment reminders (85 percent). 70 percent continued app usage for six months, with the same percentage using it multiple times per week, making the app very ‘sticky’. Other features were wellness tips, care team reminders, care team messaging and announcements. Average participation was 48 weeks. ‘My Appointments’ was created about halfway through the study (January 2010) and other rolling changes were made. The regional US Army Community-Based Warrior Transition Units (CBWTU), which coordinate care for soldiers who receive outpatient care in civilian facilities due to distance from military facilities (and Guard/Reserve status), enrolled 497 veterans in five states who required at least six months of complex care. Satisfaction was high, with 78 percent of soldiers stating that mCare improved their experience in the transition unit, and half of the 75 care teams reporting that they saw an improvement in appointment attendance among patients using mCare.  The results are strong and mCare continues to be used by the Army. The study was headed by Col. Ronald K. Poropatich, MD, Deputy Director of the Telemedicine & Advanced Technology Research Center (TATRC).

Unlike most other research studies, this one had some unusual hurdles to overcome. There were significant changes in ownership of mCare’s contracting company during the main study period (May 2009-April 2011, with a follow on study completed December 2012). First developed by AllOne Mobile [TTA 20 Nov 2009] with security provided by partly-owned Diversinet, AllOne ‘zeroed out’ of business halfway through the study [TTA 20 April 2010], with Diversinet picking up the program after a legal wrangle. mCare was named one of the US Army’s ‘Greatest Inventions’ in September 2011. Diversinet itself, after a seemingly successful period having its MobiSecure platform adopted by AirStrip [TTA 24 Feb 2012], a five-year, $5 million Canadian distribution deal [TTA 14 Jan 2011] and continuing military contracts, could not pull itself into financial health and was acquired by ‘velocity of big’ IMS Health for a small $3.5 million last August. Additional study coverage in Mobihealthnews and iHealthBeat.

If you are having telehealth terminology turmoil

April 11, 2014 | by

…consider the US Government. A survey of 100 respondents across 26 Federal agencies participating in the Federal Telemedicine (FedTel) Working Group presented multiple definitions of telehealth in use by agencies. Combining iHealthBeat’s summary with some extra commentary in Becker’s:

The Agency for Health Research and Quality defines telehealth based on evolving technology and adopted definitions for telehealth that fit the technology being used;

CMS and the Office of the National Coordinator for Health IT (ONC) both define telehealth as the use of telecommunications and IT to provide access to diagnosis, health assessment, information and patient care;
The Health Resources and Services Administration defines telehealth as “the use of electronic information and telecommunications technologies to support long-distance” health care and lists some of the specific technology used to transmit data; and
The Indian Health Service uses specific health technologies in its definition, such as videoconferencing and remote patient monitoring. (Becker’s: the “telehealth toolkit encapsulates real-time videoconferencing, store-and-forward consultation, secure messaging, remote patient monitoring and mobile health services.”)

The report found that definitions also varied for health-related agencies outside of HHS. For example:
The National Institute of Standards and Technology (NIST) uses the American Telemedicine Association’s (ATA) definition;
The Department of Agriculture uses definitions of specific technology such as electronic health data and telecommunications; and
The Department of Veterans Affairs (VA) defines telemedicine as something that should be used “with the intent of providing the right care in the right place at the right time.”

One wonders if the FedTel members spend a good deal of governmental time defining their definitions and sorting through the variations. Which is why, for our readers in over 120 countries, your Editors try to stay away from the ‘inventive and idiosyncratic’ and mainly stick with the definitions you see in our right sidebar. Becker’s Hospital CIO. Full study published in Telemedicine and e-Health (May) courtesy of Becker’s.

First kick at World Cup will be by exoskeleton-equipped paraplegic

April 10, 2014 | by
[grow_thumb image=”https://telecareaware.com/wp-content/uploads/2014/04/Exoskeleton_WEB.jpg” thumb_width=”170″ /]A Duke University team’s robotic exoskeleton will be worn by a Brazilian for the ceremonial first kick at the first World Cup match (Brazil-Croatia) in São Paulo in June. According to Mashable, the development of the lightweight alloy (though not in appearance from the video) body assistive ‘walking suit’ is by a multi-national team headed by Duke professor Miguel Nicolelis. The suit is connected to an electrode cap that uses brain waves to direct physical motion, enabling the wearer to ‘think and move’. Prof. Nicolelis has trained nine Brazilian paraplegics, ages 20-40 with different types of paralysis, to use the suits, and three will participate in the opening ceremonies. Guardian (also illustration) Duke University video (Mashable).

Stick on that comfy sensor patch

April 10, 2014 | by | 3 Comments
[grow_thumb image=”https://telecareaware.com/wp-content/uploads/2014/04/skinpatch-1-John-Rogers.jpg” thumb_width=”150″ /] From the head researcher (John Rogers at the University of Illinois at Urbana-Champaign) who brought you biodegradable implanted batteries and sensors [TTA 26 March], comes an almost tattoo-like stretchable sensor conforming to the skin which uses off-the-shelf, chip-based electronics for wireless monitoring. It is envisioned for wireless health tracking connecting to smartphones and computers, and for vital monitoring such as ECG and EEG testing, although this Editor would not use the term ‘clinical’ as Gizmodo has done (it is probably at the fairly sound level of an AliveCor.) However the article points out the advantages in long term use–adherence to skin is far more reliable, no dangling pendants or clunky bracelets, and it allows for multiple sensors to be worn comfortably. This type of patch would also be far kinder to the delicate skin of babies and the elderly. For them, it would make consistent long-term telehealth monitoring (e.g. blood pressure, ECG, O2, blood glucose) far easier over time. Perhaps the core of this is the PERS of the future with gait tracking and fall detection. Cost isn’t mentioned, but off the shelf elements undoubtedly are less expensive than custom/bespoke. Published in Science 4 April (abstract and summary; full text requires log in) Also see Editor Charles’ earlier take–maybe Mr. Rogers should speak to him!

Soapbox: How healthcare disruption can be sidetracked

April 10, 2014 | by | 3 Comments

[grow_thumb image=”https://telecareaware.com/wp-content/uploads/2014/04/Thomas.jpg” thumb_width=”170″ /]Ron Hammerle’s comment on Disruptive innovation in healthcare hasn’t begun yet: Christensen (TTA 31 Mar), posted on LinkedIn’s Healthcare Innovation by Design group, made the excellent point that a potentially disruptive and decentralizing healthcare service–retail clinics–has been sidetracked, at least in the US, leaving an open question on their reason for being. This Editor thought it was worthy of a Soapbox. Mr. Hammerle knows of what he speaks because his Tampa, Florida-based company, Health Resources Ltd., works with retail and employer-based clinics to connect them via telemedicine/telehealth systems with medical centers.

When Clayton Christensen first anticipated that retail clinics would be disruptive to the established healthcare industry, their business model was potentially disruptive. What has subsequently happened, however, is a prime example of how potentially disruptive movements can be sidetracked.

After acquiring MinuteClinic and laying the foundation for taking retail clinics national, CVS Caremark chose to make deals with hospitals, which could easily afford to rent, open and operate such clinics without making money on the front end or facing real disruption. Retail clinics were a loss leader to hospitals in exchange for large, downstream revenues, and slightly-enhanced market share for the retailer’s pharmacy.

After CVS shocked Walgreens with one-two punches involving MinuteClinic and Caremark acquisitions, Walgreens came back with three counter-punches of its own:

1. They doubled the number of their clinics (to 700) in less than two years, thwarted AMA opposition, leapfrogged ahead of CVS in clinic count and totally changed the retail clinic model by setting up politically-invisible, broader service, make-your-profit-up-front, employer-based clinics. (more…)